Accredited Radiology Residency Program Essentials

I. Introduction

This document was developed to describe in detail the structure and content of a veterinary radiology residency training program which will meet the expectations of the American College of Veterinary Radiology (ACVR) and to act as a guide for institutions desiring formal accreditation by the ACVR of their radiology residency training program.

II. Objectives

Veterinary radiology encompasses a variety of diagnostic imaging techniques, including the following five core areas: all aspects of Roentgen diagnosis; diagnostic ultrasound; computed tomography (CT); magnetic resonance imaging (MRI); and diagnostic nuclear medicine. All residency training programs must offer a quality postdoctoral medical educational experience of adequate scope and depth in these five areas.

III. Training Period

The program shall offer a minimum of 3 years (36 months) of postdoctoral medical education in veterinary radiology, of which at least 30 months of training must be supervised clinical experience.

IV. Direction and Supervision

Program Director

The program director, in addition to supervising and administering the training program in veterinary radiology, must also be actively involved in the training and instruction of residents.

• The director must be an active Diplomate of the ACVR and must contribute sufficient time (at least 50% clinical assignment) to the training program to ensure adequate direction.

Faculty

The faculty in the program must be qualified in those areas in which they are assigned to instruct and supervise residents and must contribute sufficient time to the program to ensure adequate instruction.

• A single faculty member must accept PRIMARY responsibility for training in each of the five core areas. Individual faculty members may assume primary responsibility and contribute to training in multiple areas, but a single individual must assume primary responsibility for each of the five training areas.
• The individuals assuming primary responsibility for training in an area need not be Diplomates of the ACVR if sufficient expertise can be documented.
• Assigned areas of instructional responsibilities and an abbreviated CV (No more than 1 page) of each faculty member must be included that documents expertise in the area of primary training responsibility.
• The faculty must be committed to the teaching of the residents and the time and effort they devote to the educational program must be documented.
• The faculty of the program must include at least two Diplomates of the ACVR and two each from the American College of Veterinary Pathology, American College of Veterinary Internal Medicine, and the American College of Veterinary Surgery.
• The number of residents in the program cannot exceed twice the number of ACVR Diplomates in the faculty.

V. Affiliation Agreement

When the resources of two or more institutions are to be utilized for the clinical education of a resident in veterinary radiology, letters of agreement must be provided.

VI. Facilities

The program must provide adequate space, equipment, and other pertinent facilities to ensure an effective educational experience for residents in veterinary radiology. The facility must have on-site access to modern radiographic equipment including fluoroscopy, modern B-mode ultrasound, and either computed tomography or MRI. Veterinary patients in the training facility(ies) must have regular on-site access to these modalities where residents can be expected to be involved in the acquisition and interpretation of such studies.

Access to equipment to support the other core areas need not be on-site, but in those instances organized and maintained self study modules with actual imaging studies from these modalities must be available.

VII. Clinical Resources

The program in veterinary radiology must provide a sufficient volume and variety of patients for instruction and in addition to dogs, cats, and horses, must include food and exotic animals. If caseload is low, organized teaching files in under-represented species may be substituted. The imaging caseload of the program must be greater than 7,000 imaging studies1 annually, if the program is to be completed within the minimum 36 month period.

VIII. Training Content

The program must provide an adequate depth and breadth of clinical experience.

• Clinical rotations must be a directed educational process.
• Unsupervised clinical responsibility alone does not constitute a suitable educational experience.
• The resident must dictate or type out timely reports from the imaging caseload.
• The program must have sufficient infrastructure to have dictations transcribed such that reports for all imaging studies are available in typewritten or electronic form in a timely fashion (48 hours).
• The vast majority (at least 80%) of typed reports generated by a resident must be reviewed and approved by at least one faculty member of the program. All effort should be made to have at least two ACVR Diplomates present at every rounds where resident reports are reviewed.
• The clinical training must provide for supervised, progressive responsibility for interpretation and progressive responsibility for quality control of diagnostic studies, and must ensure that the supervised resident performs those procedures commonly accepted in all aspects of diagnostic imaging offered by the program.
• At a minimum, the time commitment for the core clinical training shall consist of at least 12 months in diagnostic radiology, at least 6 months in diagnostic ultrasound, and at least 3 months in computed tomography and/or MRI, regardless of the caseload of the institution. These are expected to be distributed throughout the 36 month training program.
• The program must provide residents meaningful experience in MRI, CT, and nuclear medicine, even if one of these modalities is not on site.
• Clinical rotations may be scheduled concurrently, when facilities and caseload permit. If residents are assigned to multiple services simultaneously, the time credit is not additive. In other words, a resident involved in all of the small and large animal radiology, CT, and ultrasound cases for one month receives only a total of one month credit distributed between the service areas. In these situations, the appropriateness of the distribution is the discretion of the institution, but should reflect the relative time commitment of the resident.
• Thus of the 30 months of required clinical training, 21 are prescribed (12 months radiology, 6 months ultrasound, 3 months CT and/or MRI). The unprescribed 9 months of required clinical training are to allow residents to gain either greater depth of clinical training in the prescribed areas or in unprescribed areas such as nuclear medicine and echocardiology.
• Time spent away from the clinic on research projects is not considered clinical training.
• During the 30 months of required clinical training, the full time equivalent commitment to clinical service is calculated based on the assumption the resident is involved in the interpretation of a minimum of 70% of all examinations presented to the service(s) to which they are assigned. The remainder of the time is to be dedicated to course work, self study, teaching assignments, and vacations. Being involved in the interpretation means the resident must be present at the time the study is initially interpreted. Merely attending rounds or reviewing cases is not considered being involved with interpretation. A greater than 70% commitment still only counts as full time (not more than 100%).
• It is expected that this amount of experience would result in the resident being involved in the interpretation of a minimum of approximately 4,000 radiographic studies(1) in small and large animal radiology, a minimum of 1,000 studies in diagnostic abdominal ultrasound, and a minimum of 500 CT and/or MRI imaging studies during the course of the entire program.
• More than one resident can be involved with a single study.
• Each resident must have supervised experience in basic interventional procedures, such as image guided biopsies or fine-needle aspirates.
• Pathology is considered the basis for radiologic diagnosis, and the resident must be given the opportunity to attend pathology rounds or have access to written pathology reports generated from the imaging case load.

Formal didactic classes or organized self-study modules must be included in:

• Radiobiology
• The physics of:
  • diagnostic radiology
  • nuclear medicine
  • ultrasonography
  • CT
  • MRI

Formal courses, organized self-study modules or supervised practical experience must be included to provide the resident knowledge of the basic patterns of disease and principles of interpretation of disease in:

• Diagnostic nuclear medicine
• Echocardiology
• Large animal ultrasound
• MRI
• CT

The radiologic education in different organ systems should provide the opportunity for residents to develop adequate knowledge regarding normal and pathologic anatomy and physiology, including the biologic and pharmacologic actions of materials administered to patients in diagnostic studies.

If an optional graduate degree is available in the program, the impact of the degree option must be explicitly stated. If the optional degree program dilutes the clinical experience below the 70% clinical commitment, during the first 36 months of the program it must be submitted as a separate alternative program.

IX. Research Environment

The program should provide an environment in which a resident is encouraged to engage in investigative work with appropriate faculty supervision. These projects may take the form of basic research in research laboratories or an assimilation of well-analyzed clinical material or even the reporting of individual cases. Documentation of this environment should be made in the institution's application and indicated by published papers or scientific presentations by residents and/or clinical faculty.

X. Educational Environment

The education in diagnostic radiology should occur in an environment which encourages the interchange of knowledge and experience among residents and staff in the program, as well as with residents in other major clinical specialties located in those institutions participating in the program.

Residents should be provided ample opportunity to present formal lectures. It is expected that each resident will prepare and present a minimum of 3 lectures or scientific presentations during the course of the residency training program.

XI. Evaluation

The in-training evaluation of resident performance and progress must be documented at least yearly through appropriate techniques, including faculty appraisal, oral or written tests, or a combination of these. One measure of the quality of the program is the performance of its graduates on examinations for certification by the ACVR.

XII. Teaching File

A teaching file of images referable to all aspects of diagnostic imaging must be available for use by residents. This file should be indexed, coded, and currently maintained.

XIII. Conferences

Conferences and teaching rounds must be correlated and provide for progressive resident participation. These should be not only intradepartmental conferences, but should involve each major clinical department. They should be of sufficient frequency and include both residents and staff participation on a regular basis.

At least 12 Known Case Conferences must be provided annually.2

XIV. Literature Resources

The program shall provide a sufficient variety of journals, references, and resource materials pertinent to progressive levels of education in diagnostic radiology and associated fields, all of which should be immediately accessible for resident study. In addition, residents should have access to a general medical library.

Footnotes:

1) An imaging study is defined as a study of an anatomical area (e.g., thorax, abdomen, fetlock, stifle, etc.). Multiple examinations may be performed on a single patient. A heavy caseload cannot reduce the minimum time commitment; however, a low caseload may extend the actual time commitment beyond the minimum.

2) In Known Case Conferences the faculty selects cases that the resident has never seen, and where the diagnosis/outcome has been unequivocally confirmed. These cases are then presented to the residents as unknowns. These conferences may take different forms, but they must be designed to test the progress of the resident's pattern recognition and medical decision making skills.